Post on 10-Nov-2021
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Philadelphia Housing Authority
Contractor or Vendor Business Certification
Name of Business _____________________________________________________________________________
Address of Business ____________________________________________________________________________
Type of Business (Check One): Corporation Partnership Sole Proprietorship Other
Description of Business Activities:
_______________________________________________________________________
All firms and individuals intending to do business with the Philadelphia Housing Authority MUST complete and
submit this Action Plan and submit it with their bid, offer, or proposal. Any solicitation response that does not
include this document (completed, signed, and notarized) will be considered non-responsive and not eligible for
award.
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Contractor Self-Certification of Business Concern Status
I am certifying as a Section 3 business concern and requesting preference to comply with requirements of
Section 3 throughout the life of the contract (Select only one option):
1. Vendor identifying themselves as a business concern that is 51% or more owned by a Section 3 Resident:
a. A business claiming business concern status as a Section 3 Resident-Owned Business Concern
(ROB) entity and has completed forms 1, 6, 7a-c, and 9b :
Initial here to select this option __________
b. A business claiming business concern status as based on its workforce of 30% or more full time
Section 3 Residents or persons who were Section 3 Residents within 3 years of employment and
has completed forms 1-3, 6,7ac,e, and 9a; or
Initial here to select this option __________
c. the business subcontracts more than 25% of the contract amount to Section 3 business concerns
(vendor must identify subcontractor and submit completed required forms for option a or b
depending on the subcontractor business concern status)
Provide a list of intended subcontract Section 3 business(es) with subcontract amount
Provide certification & all supporting documentation for each planned subcontract Section 3 Business
Initial here to select this option __________
Note: Business concern status is approved upon submission of all materials listed. Status must be met at the time of
proposal and prime contractors cannot claim Section 3 Status by further subcontracting. Additional documentation
is required for joint ventures that claim this status.
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FORM – 1
EXISTING EMPLOYEE LIST
A. PROJECT NAME AND LOCATION:
B. DEVELOPER/CONTRACTOR /APPLICANT: C. DATE:
EMPLOYEE NAME/ADDRESS
SOCIAL SECURITY
NUMBER (LAST 4 DIGITS)
JOB
CATEGORY/TRADE
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FORM – 2
HIRING LIST
All awarded contractors who have selected to meet their Section 3 requirement through hiring, must complete and submit this form to the
Philadelphia Housing Authority. The Philadelphia Housing Authority expects employment retention throughout the life of the contract.
Prime Contractor’s Name Contract #
Job Category
Total Expected
New Hires Needed for Contract
Total Expected Number of
Workforce Man hours Needed for Contract
Total Number of Positions
Currently Occupied by
Core Employees
Total Estimated Number of
Workforce Man hours to be
Performed by Current Core Employees
Total Estimated Number of
Workforce Man hours to be
Performed by Section 3 Residents
Apprenticeship Confirmation
Total # of Expected Section 3
New Hires in each
Category
Total Expected Number of
Section 3 New Hires that will be Apprentice for “On The Job
Training”
List Types of Pre- Apprenticeship or
“On The Job Training” Positions Available to Section
3 Residents
List The Name Of The Training
Program Provider
(If Applicable)
What Type of Certification Will Be Provided At The Completion
of Training (If applicable)
Note: Apprenticeships are recognized as “on the job training”, therefore accepted as new hires. An apprentice is anyone who works for a skilled or qualified person in order to learn and or gather instruction in a trade or profession for a recognized period.
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FORM – 3
EFFORTS TO COMPLY WITH SECTION 3
HIRING AND CONTRACTING GOALS
NARRATIVE
Please describe in a narrative the efforts you plan to make or have already made in order to
comply with Section 3 Hiring and Contracting goals.
CONTRACTING PLAN (if applicable) FORM-4
List Each and Describe
Briefly
Subcontractor
(A)
Approximate Dollar
Value
(B)
Construction (C) or
Non-Construction
(NC)
(C)
Section 3 Business
Concern (Y/N)
(D)
Ethnic Racial Code
(E)
Female Owned/
Minority Owned
Business (Y/N)
(F)
1. $
2.
$
3.
$
4.
$
5.
$
6.
$
7.
$
Ethnic/Racial Codes: 1. White American 4. Hispanic American
2. African American 5. Asian Pacific American
3. Native American 6. Hasidic Jew
SUBCONTRACTOR ACTIVITY REPORT (if applicable)
FORM-5
Contract Number:
(A)
HUD Funding Source:
(B)
Date:
(C)
Contractor:
(D)
Address:
Project Name and Location:
(E)
Actual Construction
Start Date:
(F)
Name of Subcontractor
Complete Address and Tax
I. D. Number
(G)
Amount of Contract
(H)
Ethnic/Racial
Code
(I)
Gender
Code
(J)
Section 3
Business
Concern
(Y/N)
(K)
Type (s) of Services
Provided
(Including
Supplies)
(L)
Anticipated Start
and Completion
Date:
(M)
#:
$ From:
To;
#:
$ From:
To:
#:
$ From:
To;
#:
$
From:
To:
#:
$ From:
To:
Ethnic/Racial Codes: 1. White American 3. Hispanic American
2. African American 4. Asian Pacific American
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P H I L A D E L P H I A H O U S I N G A U T H O R I T Y S E C T I O N 3 R E S I D E N C Y
S E L F – C E R T I F I C A T I O N F O R M F O R M – 6
INSTRUCTIONS: Please complete this form to verify your qualification as a Section 3 resident. If you are an employer, please submit this form (to be completed by the Section 3 resident) with a copy of the Section 3 resident’s photo identification to PHA’s Section 3 Program. 1) I, _____________________________________, (PRINT NAME) am a legal resident of the
City of Philadelphia and am either a resident of Philadelphia Housing Authority (“PHA”) housing or meet the income eligibility guidelines for a low or very low income person, as set forth on the next page.
2) I certify that I am a Section 3 resident because: I am a PHA resident and my Client ID # is: _____________________, or I am City of Philadelphia resident (The questions below must be completed if you are not a PHA resident)
There are a total of _____ people living in my household and My household income is $________________/month and $________________/year.
(Multiply your monthly income by 12 to calculate your yearly household income)
3) My home address and phone number are: ______________________________________________________________________ (MUST BE A STREET ADDRESS NOT A P.O. BOX #) (APT. NUMBER) ______________________________________________________________________ (PHA SITE NAME – IF APPLICABLE) ______________________________________________________________________ (CITY) (STATE) (ZIP) (HOME TEL.) (CELL NO.)
4) The last four digits of my social security number are: I certify that all of the information given above is true and correct. If found to be inaccurate, I understand that I may be disqualified as an applicant and/or a certified Section 3 individual which may be grounds for termination of training, employment, or contracts that resulted from this certification. I attest under penalty of perjury that my total household income annually, based on my total household size as listed above is at or below the income amount for that specific size at the time of this document is being signed. I understand that proof of this statement may be requested in the future.
_____________________________________ ___________________________ Signature Date
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SECTION 3 HUD INCOME LIMITS (Effective 7/22/14)
All residents of public housing developments of the Philadelphia Housing Authority qualify as Section 3 residents.* Additionally, individuals residing in the City of Philadelphia where Section 3 contracted work is being performed, who meet the income limits set forth below, can also qualify for Section 3 status
Eligibility Guideline
Number in Household Very Low Income Low Income
1 individual $ 27,600 $ 44,150
2 individuals $ 31,550 $ 50,450
3 individuals $ 35,500 $ 56,750
4 individuals $ 39,400 $ 63,050
5 individuals $ 42,600 $ 68,100
6 individuals $ 45,750 $ 73,150
7 individuals $ 48,900 $ 78,200
8 individuals $ 52,050 $ 83,250
* Section 3 is a provision in the Housing and Urban Development Act of 1968 (12 U.S.C. Section 1701u and 24 C.F.R. Section 135.1). Its purpose is to ensure that economic opportunities, to the greatest extent feasible, are given to low and very low-income persons, particularly to recipients of government housing assistance. Section 3 job opportunities relate to new hiring due to contracts with PHA. Section 3 residents are PHA residents, or persons who live in the City of Philadelphia who have a household income that is low income or very low income under HUD’s income limits.
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AFFIDAVIT FOR BUSINESS CONCERNS SEEKING SECTION 3
PREFERENCE IN CONTRACTING AND DEMONSTRATION OF CAPABILITY
(if applicable) FORM-7
The undersigned, being first duly sworn, on oath represents, warrants, certifies, deposes and
says, under penalty of law, as follows:
Name of Business (the “Company”) ________________________________________________
Address of Business_____________________________________________________________
Type of Business: Corporation Partnership
Sole Proprietorship Joint Venture
Attached is the following documentation as evidence of status:
For Business claiming status as a Section 3 resident-owned enterprise:
Copy of resident lease Copy of receipt of public assistance
Copy of evidence of participation Other evidence
in a public assistance program
For business entity as applicable:
Copy of Articles of Incorporation Certificate of Good Standing
Assumed Business Name Certificate Partnership Agreement
List of owners/stockholders and Corporation Annual Report
% ownership of each Latest Board minutes appointing officers
Organization chart with names and titles Additional documentation
and brief function statement
For business claiming Section 3 status by subcontracting 25 percent of the dollar amount
awarded to qualified Section 3 business:
List of subcontracted Section 3 business(es) and subcontract amount
For business claiming Section 3 status, claiming at least 30 percent of its workforce are
currently Section 3 residents or were Section 3 eligible residents within 3 years of date of
first employment with the business:
List of all current full-time employees List of employees claiming Section 3 status
PHA Residential lease less than 3 Other evidence of Section 3 status less
years from day of employment than 3 years from date of employment
NOTE: Current HUD income limits for Section 3 residents may be found by going to
http://www.huduser.org/portal/datasets/il/il11/index.html and selecting the Philadelphia region.
The Company hereby agrees to provide, upon request, additional documents verifying the information provided above.
A.
B.
C.
D.
E.
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Under penalty of perjury, I certify that I am the (Title) of the
Company, that I am authorized by the Company to execute this affidavit on the Company’s
behalf, that I have personal knowledge of the certifications made in this affidavit and that the
same are true.
(Corporate Seal)
Signature
Name
Commonwealth of Pennsylvania
County of
Subscribed and sworn to before me this _________ day of ___________________, __________
Notary Public
My Commission expires:
F.
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SECTION 3 RESIDENT AFFIDAVITS
FORM – 9A
I, , the Developer/Contractor, or the authorized
representative of the Developer/Contractor, do hereby attest that I have examined the proofs of
residency and income for each person signing a Section 3 Resident affidavit (FORM-5) as a low or
very low-income person and or a resident of the Philadelphia Housing Authority. I also attest that
the proofs supplied and representations made for Section 3 status are accurate as required by
Section 3 of the U.S. Housing and Urban Development Act of 1968, as amended and the
regulations.
I fully understand that this affidavit is a substantive part of the contract and that intentional
submission by the developer/contractor of false information shall be a material breach of the
contract, and that the Philadelphia Housing Authority may exercise those rights provided to it under
the contract by law.
Developer/Contractor Signature Date
Contract number Work Site Position/Title
Commonwealth of Pennsylvania
County of
Subscribed and sworn to before me this day of ,
Notary Public My Commission Expires:
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SECTION 3 BUSINESS CONCERN AFFIDAVIT
FORM – 9B
I, ________________________, the Developer/Contractor or the authorized representative of the
Developer/Contractor, hereby attests that the Business identified below is a Section 3 Business
Concern. I also attest that the proofs supplied and representations made for Section 3 status are
accurate as required by Section 3 of the U.S. Housing and Urban Development Act of 1968, as
amended and the regulations.
Name of Section Business
Contract No. Dollar Amount of Contract
Contact Person Phone Number
Reporting Period
Project Name
This Section 3 Business Concern is:
Corporation Partnership
Sole Proprietorship Joint Venture
Qualifying Business:
1. 51% owned by Section 3 low income residents.
2. 30% Section 3 low income residents dollar award.
3. 25% of contract work committed to subcontract to Section 3 Business Concerns.
I do certify that the above information is correct.
Signature Title